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2023 TEXAS LEGISLATIVE
SESSION WRAP-UP

In a 2006 JAMA® issue, Gruen, et al. wrote about the community undermine university aspirations to objectivity and neutrality.”
participation, political involvement and collective advocacy roles of While I can appreciate his perspective, and respectfully leave the op-
physicians. In this article, they “reviewed physician responses to the In- tion up to the individual physician, recent developments have made
stitute on Medicine as a Profession’s (IMAP) survey to assess physi- the imperative to action much more timely. For those physicians who
cians’ feelings toward advocacy and their participation in public have considered political advocacy and have declined, we must re-
advocacy activities.” These activities were grouped into three types of spect their decision. But for those that have never been politically
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activity: community participation, individual political activity and col- active, they should realize the opportunity that exists before them.
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lective (organizational) advocacy. The intent of those individuals in deciding how to practice medicine
In 2010, Earnest, et al. wrote an article in Academic Medicine asking is of the utmost importance, even after their clinical duties have been
“what is physician advocacy and how do we do it?” These thought lead- completed. Maybe it is just me, but as cost goes up and quality goes
ers have attempted to provide a more robust operational definition in down in American healthcare delivery, especially for the most vul-
the specific contacts of physician advocacy, as “action by a physician to nerable, I can no longer support the status quo.
promote the social, economic, educational and political changes that We each need to determine for ourselves how we define the art of
ameliorate the suffering and threats to human health and well-being medicine. It can represent an opportunity to emphasize beneficence
that he or she identifies through his or her professional work and ex- and speak for those without a voice as a professional ethical standard.
pertise.” Certain obligations are linked to membership in various com- I’ve heard politically savvy persons say, “If you don’t have a seat at
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munities. Fundamental moral and ethical obligations are linked to the the table, it is likely that you are lunch.” Is that just an unfortunate,
basic nature of the profession. They also discuss actual and perceived dirty, secret fact about politics? If so, I interpret that as only more rea-
barriers to advocacy activities by physicians. son to become involved to better practice self-care for physicians and
In 2011, the president of the Missouri State Medical Association healers, and to influence how medicine is practiced in Texas and the
was Gary Pettett, MD. His article was entitled “Obligation or Op- United States by learning and sharing the teachable advocacy skills that
tion? The Physician’s Role in Advocacy.” The entire November-De- have been developed. We should encourage students to become in-
cember issue of that group was dedicated to the physician’s role in volved early and help guide them to better balance this additional duty
advocacy. It was admitted that physician political advocacy has not according to their capabilities.
been clearly defined. He continued to attempt to provide back- Especially as we concentrate on physician self-care in this post-pan-
ground on the issues and controversies surrounding physician advo- demic period, let’s make sure we don’t become lunch!
cacy, and discussed barriers to activity. He asked whether advocacy
was part of professionalism, or should it be relegated to civics, and References:
cited an article by TS Huddle, MD. In the name of fair and balanced 1. Gruen RL, Campbell EG, Blumenthal D. Public Roles of US
writing, I mention his opinion. Physician. Community Participation, Political Involvement and
Dr. Huddle has a different take on physician advocacy, and he Collective Advocacy. JAMA. 2006;296(20):2467–2475
wrote of this in 2011 in Academic Medicine. While I can appreciate 2. Earnest MA, Wong SL, Federico SG. Physician Advocacy: What Is
his perspective, with the recent changes in the makeup of the U.S. It and How Do We Do It? Acad Med. 2010;85(1):63–67
Supreme Court and their willingness to reverse laws passed by Con- 3. Huddle TS. Medical Professionalism and Medical Education
gress, it is incumbent on the family of medicine to defend itself Should Not Involve Commitments to Political Advocacy. Acad
against the erosion of its well-deserved authority in medical matters. Med. 2011;86(3):378–383
He does not agree that political advocacy is a core professional re-
sponsibility for physicians. He argues that “(1) civic virtues are out- John J. Nava, MD, is the 2023 President of Bexar County
side the professional realm, (2) even if civic virtues were Medical Society. He is interested in Primary Care, Clinical
professionally obligatory it is unclear that civic participation is nec- Research and Public Health.
essary for such virtue, and (3) the profession of medicine ought not
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to require any particular political stance of its members.” He also
believes that academic centers should not be “systematically involved
with fostering advocacy.” He holds that advocacy “seeks change
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rather than knowledge,” so has no claim on curricula including ad-
vocacy skills as an academic concern. He thinks these efforts “will

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